Implementation of telemedicine: the problem of evaluation.

In the UK, few telemedicine applications have endured beyond the trial phase. It is commonly said that lack of evidence is responsible for the lack of implementation. This assumes that evidence will lead to implementation. Studies show that this is naive, especially in organizations like health-care systems, which are characterized by professional dominance. Furthermore, other research indicates that the nature of the changes experienced by clinicians in telemedicine experiments is sometimes limiting compared with conventional practice. This presents a dilemma for evaluation since it cannot reliably take place until a particular technique has become stable and accepted into the daily routine. A programme of selected case studies is recommended to develop knowledge of how telemedicine can become a taken-for-granted part of medical care.